Provider Demographics
NPI:1184177008
Name:PETERMAN, MARLA M (CRNP)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:M
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4217 NORTHERN PIKE
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2713
Mailing Address - Country:US
Mailing Address - Phone:412-372-9100
Mailing Address - Fax:412-372-6952
Practice Address - Street 1:4217 NORTHERN PIKE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2713
Practice Address - Country:US
Practice Address - Phone:412-372-9100
Practice Address - Fax:412-372-6952
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103185270Medicaid